I looked down at his small body, thinking that this time, I would make a difference.

He was breathing 2 minutes ago.

He was at school earlier that same day.

Maybe its just respiratory arrest?

He had a pulse as we moved him from the front room where I found him lying on the settee, looking nothing like a young boy sleeping, but instead like a much younger version of the hundreds of patients that have either died in my presence or have been dead before I even had a chance to help them.

I placed him onto the stretcher, carrying him out of the house in my arms rather than placing him on a carry chair.

He was small for a teenager.

“Does he normally have any medical problems Mum?”

“No……nothing”

My partner puts the leads on his body whilst I give him a couple of breaths.

“Good rhythm!!”

“Does he have an output with that??”

We both check………

Mum is standing at the back door of the ambulance, a look of blissful ignorance on her face, certain that we will help her son.

I look down at him, then I turn my head to the side and quickly glance at mum.

Silently, I curse to myself

As I start compressions I try harder than I have ever tried before to block out the sounds of his mother screaming at the back door of the ambulance, and I know that in that one moment, I will never, ever forget that sound.

Sometime, very shortly, this blog will disappear from the Fire&EMS Blog Network. This is no reflection what so ever on the Network, on the contrary, the exposure that being part of such an esteemed group of EMS Bloggers and having access to the readership of JEMS has had a large impact on the readership of my musings!

I have been in touch with the chaps in charge of the site and have asked for my domain to come to me so that I can move the archives of 999Medic to a self hosted site, where they can be viewed by whom ever wants to. I feel it would be a shame to have over 600,000 words just disappear!

As for active blogging, I am done.

It has been a fantastic two years. Friendships have been formed, memories have been created, and I truly feel privileged to be part of such a professional group of people as those that write and read EMS Blogs.

I hope that my writing has meant something to you all (although I already know that, thanks to a number of emails and comments), but please know that you have all given me so much too.

The ending of 999Medic is different this time, to the last ‘sabbatical’. This time it is my choice, this time I feel that it is the right thing to do.

I don’t know what has changed in me over the last couple of months. Maybe I am heading for burnout…..Maybe I am already there. I guess that just goes to show that it can happen to anyone.

There has been no big single incident, but I find myself constantly thinking about what else is out there, and I imagine the bliss of being unaware of the despair that some families have to go through. I think about not seeing the things that I have seen, and not having to deal with the ‘splashed sadness’ that we are so often a part of (that term really should have a place in EMS history – Kudos again to Mr Chris Kaiser).

Where my career will take me, I have no clue at the moment. I am looking at options, and am enthused and thrilled with the academic learning that I am part of at the moment and have already looked into a PhD in three years time.

What I do know, for certain, is that I wont be a bitter front line paramedic who remains in a job that is slowly killing him as he struggles to keep up with the ever increasing physical demands put on him.

I still have so much to give. I still love healthcare and looking after people.

I always said that this blog would be a positive place to come, but it is hard to maintain that when I myself do not feel that positive about things. This is no reflection on my service at all, more the state of the public’s perception and expectation of EMS services. It has becoming draining, and it has sucked much of the enthusiasm out of me.

I really don’t think I will be back as a blogger, but I will still be on Twitter (@UKMedic999) and on Facebook. I will of course, still be reading all of my favourite blogs and commenting when I have something to add to the discussion.

As I am sure that you have noticed, the frequency of my posting is not that great at the moment.

If you have been following me on twitter, you will know that it has been a particularly tough couple of months with one thing or another, which hasnt exactly put me in the writing frame of mind.

However, the main reason for me not blogging is that I am not in a good place at the moment with my work. I have a lot of frustrations, with my role and what is happening to the ambulance service as a whole at the moment.

I have wrote a number of posts recently which will never see the light of day on the internet. I have always said this wouldnt be a negative blog and I would never do anything to harm the relationships with my employers, even though my concerns are bigger than just my service.

I have been thinking of ending the blog again. This time on my terms, with no outside influence from management.

I keep putting off because I know how I felt last time, and how much I missed blogging and communicating with you all. There is a difference this time though.

As I have been posting less and less, I have not been missing it.

That may have something to do with amount of Uni work that is getting in the way of me having a normal life (but, to be honest, I am really enjoying the challenge of the MSc), but I cant help but feel that the drive of the blog has gone away.

So….I am going to ponder over the next few weeks before making my decision. If it goes, it wont be coming back this time, and I am not writing this to get the flood of wonderful comments that came the last time the blog went on ‘hiatus’, I just thought you guys should know.

I woke up this morning, rolled onto my side, reached over a still sleeping junior999 and grabbed my iphone. As is my usual morning routine, I try to keep little one asleep as long as possible, so rather than get out of bed I lie quietly reading through the latest blog posts around the EMS Blogosphere.

First stop is always ‘The Happy Medic”, and today I was reminded of exactly where I was this time one year ago.

Just a fraction over a year ago, Justin, Ted and I were standing in a function room of the Hotel Frank in San Francisco hoping that we would have a good turnout for the first ever showing of our unique look at the San Francsico Fire Department. A fly on the wall documentary taking a different approach than those before, looking at American EMS from the outside as well as the more standard approach just following medics around. This time there was a Brit in a green jump suit thrown in there as well.

The Chronicles of EMS Episode 1 was finally here!. Our followers on twitter and facebook had been hounding us since we shared snippets whilst filming in the previous November, but now everyone had the chance to see Teds vision in all of its glory.

It is still fairly surreal thinking back to that night. Justin and I mingling with those who came to be part of the premiere in person; my hi-vis jacket and Justins Turnout coat on the back of two chairs; Justin and Teds family and friends and EMS Professionals and leaders from various parts of America came together on that night.

I have memories that will last a lifetime from that night!

A year has now passed.

I managed to stay an active part of the team for a number of months afterwards, but reality set in and the strain on my family and the strain on the (non existant) budget of me tooing and froing across the Atlantic soon became evident. It was time for me to step back and watch Ted and Justin move things forward.

Although our original vision of travelling the world to visiting other EMS systems and share best practices never came to fruition, The Chronicles of EMS has now evolved into something larger that I ever thought possible.

Ted and Justin never sit still it seems, and what stated over a year ago now has become something much more.

Chronicles of EMS has now become the ‘umbrella title’ for just part of Teds vision. The show is now called ‘Beyond the Lights and Sirens’, and is now only a small part of the new ‘First Responders Network TV’ (soon to be launched). There is much, much more on the horizon from the chaps, and for those details, pop over to Justins blog and have a read.

I am so proud of what I was part of, but equally proud to sit on the other side of the Atlantic and see what is becoming of it all!

Although it is the first birthday of the showing of Beyond the Lights and Sirens, it is also interestingly only 3 days away from the 2nd anniversary of the birth of the whole thing!!

On the 18th February 2009, I sent this email to Justin :

“I know this is very early doors, but I am looking at the possibility of coming over to the states to work/observe for a week with a paramedic crew next summer. My employers are really keen and are probably going to fund it and there may also be a chance for some filming too. Is this something that you may be interested in, along with a visit over to the UK for a week afterwards to work with me and my crews??

No committment needed, just gauging opinion at the moment.”

Justins response was typically shy and modest!

“I would of course be interested in both bringing you along and seeing first hand how you handle things.

Obviously it’s in the early stages, but I’m so totally better than any other people they have in mind. hehehe

As I stand ironing Mrs999s clothes for tomorrow morning, I half hear pre-school999 and olderbrother999 playing in the hallway. It appears that they want to go upstairs and play on the xbox together (which in reality means that poor olderbrother999 will have to settle for whatever pre-school999 wants to do instead of getting his time in on Call Of Duty).

As they head off up the stairs I hear a bang and then the frantic screams of my youngest.

Knowing him as I do, I have a fair idea that he has tried to push past his older brother in a effort to get to the stairs in first place and win yet another dash to the top of the stairs. As he takes the inside line around the corner his toes have collided with the edge of the hallway wall and he has crumpled to the floor.

Having done this a number of times myself when trying to escape from the wrath of Mrs999, I am aware of the sheer agony that only males can experience (no, we are not all soft lumps, we just have a genetic disposition for experiencing higher levels of pain than the female of the species)

As I drop down to the floor and start rubbing said offsprings toes whilst gently soothing his pain away, he continues to scream and cry and tell me how much it hurts. After removing his sock just to ensure there is no horrible deformity to be seen, or nails hanging off, I quickly jump to technique number two.

“Quick!! He’s going to beat you upstairs!! Last one up smells of poo!”

He is on his feet in a millisecond and bounds off up the stairs giggling all the way.

Job done.

Which left me with just one thought…..

How much easier would our jobs be we could utilize this technique in some of our patient groups??

Sometimes in this job we can be harder on ourselves than anyone else could be.
We question ourselves…

Did I do everything I could?
Should I have done this?
Maybe I should have done that?
Have I caused ….?
Was it my fault…..?

If you were quick enough, some of you would have seen a post pop up last week. I wrote it after getting home after a night shift and a particularly tough job. I let everything out in that post and it helped me for a while.

Mrs999 woke up, read the post, and said that it ‘was too much’ . In my book that’s enough for me to take it down, so down it came.

It’s been nearly a week now and I’ve just checked up on my patient. She is still struggling, still not out of the woods, but is alive.

As far as the questions go….

Yes, I did manage her airway well enough to prevent aspiration pneumonia (which I honestly thought was very likely). Her chest x-ray is clear.

(I apologise if this reads like a pat on the back to myself – maybe it is, but I think I need it at the minute!)

It’s no secret that over the past few weeks I have been reconsidering my future and where I want to be in the next part of career. I have been looking at a variety of opportunities both inside and outside of the Ambulance Service.

Something has changed, and I am not sure what it is, but since I wrote my ‘Itchy Feet’ post, things just haven’t been the same.

Maybe it is just the run of stupidly busy shifts; the constant barrage of ‘patients’ with no apparent illness or injury that warrants going to hospital, never mind calling an emergency ambulance, or just that I am feeling very tired.

I’m sure some of it has to do with Mrs999s injury, and the concerns I now have of coming to work and having a split second incident which could jeapordise my career and earning potential.

Who knows??

However, as I sit here at my laptop at 05:11 in the morning, I have that familiar feeling of satisfaction.

That feeling of knowing that I have just made a difference. I have done what I have been trained to do, but more than that, I did it my way. (no not like that!)

My way is to work quickly, effectively and efficiently; caring for the family as well as the patient; looking at the bigger picture, and taking all the information in to make quick and decisive decisions.

It’s a simple sentence, with no particular threat to it at all, yet for some medics it is like giving them notification of some horrendous impending doom.

“Joe, you have an observer coming out with you today”

*Screeeeaaaaammmmm!!!*

They are not half as common as they used to be. There was once a time where anyone with an interest in becoming an ‘Ambulance Driver’ was welcomed to come along for a day and see what the job was really like and if it was going to be for them. I have been known to have discussions with patients relatives who have asked questions about getting into being a paramedic, which has resulted in them turning up on my station a few weeks later to spend a shift or two with me on the ambulance or on the rapid response car. All that was required was a signature on a confidentiality agreement and a health and safety form and we were off!

Things have changed. Some are necessary for the protection of our patients and one that I agree with is having someone prove that they have had a background check done and are ‘safe’ to have access to individuals at their most vulnerable state.

Other things just seem to get in the way from allowing truly interested members of the community from finding out if the possible career choice or move is really for them, before they take the plunge.

Most observers these days consist of people who are waiting to start their student paramedic training (after gaining a place) or members of the affiliated services, mostly mountain rescue and the coast guard.

What hasn’t changed is the attitude of a large proportion of medics who see the presence of an observer as another factor to get in the way of their down time or ‘relax time’ through the quiet times of the shift (as rare as they may be becoming).

I agree that having an observer out for the shift can make the day a little more of an effort. Where you would normally go into autopilot and just ‘do’, you now have to think about explaining things and answering questions. You need to develop the ‘third eye’ so that you can keep an a look out on your observer as well as the patient, your crew mate, family members, bystanders and the environment.

Your observer’s safety is your responsibility, and it isn’t one that should be taken lightly. Simple things like checking the vehicle at the start of the shift, take longer as you go through what is on the vehicle and what it is used for. Discussions need to be had about the observers experience and how much/little do they want to be involved in certain aspects of the patient experience, and what you expect from them.

After checking the vehicle, if you are fortunate enough to have time for some breakfast or a cup of coffee, you now have to make polite conversation and try to make the observer feel part of the team.

As the supervising medic, it is your responsibility to be honest, but enthusiastic about what being a paramedic is like. I have seen some poor observers, who have been lumped with medics who really don’t even want to be in the job themselves. I bet you can guess what experience the observer had on that shift!

When I take an observer out with me, I want them to go home at the very least, thinking what an amazing experience they have had. They will most likely not have seen trauma and death and all the big jobs, but they will most definitely have seen a paramedic who is passionate about what he does and the patients that he cares for.

They will have spent time with a paramedic who is striving to be the best that he can be clinically and professionally, and they will go home knowing that if they want to be a good paramedic, it is going to take hard work and dedication.

They will also get a feel for the hardships of the job too.

I have no problems in re telling the ‘bad jobs’, but it may surprise them to hear that it wasn’t the patient decapitated by the train or the fatal RTC; rather the middle aged man who looked into my eyes and told me that he was about to die and asked me to say goodbye to his children for him. They will know that I still think about him and that when I do, my eyes still fill with tears.

They will know that as far as being a profession, we are still a long way off, but we are getting there. Politics is part of the job at a government level, but also at the ground level. Politics between management and staff, and politics between medics.

If you are passionate, you will stand out, and sometimes not in a good way. It still surprises me to see that it isn’t ‘cool’ to care deeply about what you do.

Most of all though, I want my observer to come away from a shift thinking

“Yes, that’s the job for me”.

Just like Francesca did……

Below is an email I received two days ago. To say it made me feel good is an understatement. It is reproduced with the kind permission of Francesca herself.

“Hi Mark,

You probably won’t remember me, but a few years ago you took me out in a rapid response car for a couple of days observing. It was the kick-start to me actually getting around to trying to get into the ambulance service. As of October 2010 I am now a qualified paramedic. I love going to work. You played a big part in me actually doing it. I just wanted to thank you.

Kind regards,

Francesca “

Do you want to play a part in jump-starting someone’s career in EMS?

All you have to do is be a role model. Show your observers that if you put the effort in you will be rewarded in the long run.

Yes, it’s a tough job at times, but as I say to everyone who asks me if I like doing my job?

Whilst walking around Marks and Spencers, doing the food shop with Mrs999, I thought I would sneak a quick peek at my emails on the old trusty iPhone.

Next thing heard was me saying out loud

“Now that is just cool!!”

I had received an email from Bill Carey, the news and blog manager for JEMS and the Fire&EMS blog network. He sent me a picture that had been submitted onto the page of one of the JEMS Connect users (imagine Facebook for Medics) that just made me grin from ear to ear.

This is Jessie P. Alvarez, a medic from the Phillipines, and obviously a supporter of The Chronicles of EMS and EMS 2.0.

CoEMS and EMS 2.0 in the Philippines

Hopefully he will come by and see this, so that I can thank him for his support and also let him know that he made a medic all the way over in the UK stop and grin like a cheshire cat in the middle of a supermarket today!

I know that Justin (the Happy Medic) and Ted Setla have already seen this, but I am sure that this will bring a smile to the face of Chris Kaiser (@Ckemtp),Co-Founder of EMS 2.0 along with Justin, and Scott Kier (@MedicSBK) who designed the symbol for EMS 2.0.

Isnt it amazing how a message can travel around the world!!

Now if only we could find away to go and work alongside him and film another couple of episodes!!

When I used to work as a nurse, I always had itchy feet. Whenever I got settled in a job, I started to look around for whatever was next.

Don’t get me wrong, I had a plan, and I kept to it. It payed off in the end with he getting to my 5 year goal on time and becoming as proficient as a theatre nurse (O.R Nurse) as I had always wanted to be.

Then came the chance to join the ambulance service and I jumped at it. Something I had always wanted to do. I applied, sat the exams, had the interviews then started the career of my dreams.

I never looked back and surprisingly, the itchy feet seemed to disappear.

I am now 12 years in. I have never thought about doing anything else and couldn’t even imagine doing anything else. One of my colleagues once said that if they cut me in two I would be green and yellow throughout (the colour of UK ambulances).

Things change though…….dont they?

I’ve started looking, I keep on imagining…….what if??

I’m sure it’s just a phase I’m going through. I still love coming to work. I am still passionately committed to giving my patients the very best care they could hope to receive, but I can’t help but wonder……

Maybe it’s because of the MSc in Clinical Research I am doing, and once a month I go to study at the Newcastle University Medical School, and look at all the young student doctors.

Maybe it’s because as I sit in the library working on the latest assignment, I listen to the students on the tables next to mine, discussing their latest project on this disease or that ailment, and know that I could quite happily join their discussion and have relevant input into it.

I know that I am a frustrated doctor. I recognise the fact that if I could do it all again, I would actually work at school and go to medical school.

It’s too late now. My family come first and im no spring chicken, that’s for sure.

There are other options though. I could go back to nursing; I keep meaning to do some work in accident and emergency on the nurse bank.

I could work my butt off at the MSc and get a good result then try to find research work (although I know the pay isn’t as high as I thought it would be).

I have also contemplated making the jump that Tom Reynolds has recently done and go into a NHS Walk in Centre as a nurse practitioner.

Or I could just stay put and ride the wave that I am on at the moment and wait for everything to settle down again and realise what a lucky man I am to be doing this job. I know that the grass isnt always greener on the other side…..but is that enough of a reason not to try another field?

I know I am not exactly ancient, but I also recognise that I dont want to be carrying 20 stone people down stairs when I am in my 50’s.

Maybe I should change when there is still time for me to start again and move upwards?

That bothers me……..I’m not entirely sure why, but all I know is that I don’t like the sound of that at all.

“She was dead before she picked up the phone”

What I found out later was that her potassium levels were so high, that she was in effect, unsalvageable. No matter what I did pre hospital, no matter what the A&E staff did once I got her to the department, it was never going to matter. It was never going to change the course of what was about to happen.

The fact that I was talking to her all of the way in to hospital, reassuring her that she was tolerating the speed of her heart very well and that the hospital staff will be able to ‘sort it out for her’, makes it harder to accept.

“She was dead before she picked up the phone”

The fact that I was looking at the VT on the monitor screen, knowing that the hospital would be able to sort it out, makes it harder to accept.

“She was dead before she picked up the phone”

1 hour after I had handed her over to the waiting team in A&E, I managed to get back to see how she was doing. I honestly expected to see her sitting up in her bed, looking much better and telling me that she felt so as well.

What I didn’t expect was to see her lying supine on the trolley, sheet pulled up to her neck, and a concoction of syringes, ampoules, and equipment scattered all over the resus bay.

The look on the doctors faces told a story of it’s own. A story of a battle truly fought, with every last attempt made to try and stop the inevitable, but after all, it was no to no avail.

Who would have known that a couple of little blogs (mine and The Happy Medics) and the vision of a certain film maker,Ted Setla, would have such an impact on my life, both personally and professionally?

Four trips to the United States later and I was having to come to terms with the possibility of leaving all that we had worked so hard to achieve. Chronicles and Mother Nature (Icelandic Volcano) had taken their toll on Mrs999 and the rest of my family and it was time for me to decide what my real priorities were.

Jump forward 7 months, and I am looking back with a huge fondness over the experience that I have had, and the friends I have made. I have been truly privileged to have been part of this and although I am in the background now, I look forward to the time when the Ted, Justin and Mark show teams up again to bring something ‘Awesome’ to the table.

As I have wrote in the past, my exposure to worldwide EMS systems has driven me to want to be a real agent for change in the UK ambulance services (why bother aiming low, eh?), which brings me to my current studies for a Masters Degree in Clinical Research and the frankly ridiculous amount of work I am trying to fit in around my full time job.

It will be worth it though, my goals stretch far beyond 2011. However long it will take, I will somewhere along the line see some of my ideas and thoughts on how to better EMS, come to fruition and I will know that I have made some small (or maybe even large) contribution to the profession that I love so dearly.

I have been one of the very fortunate ones who managed to secure some time off over the Christmas period, and I don’t think I have ever enjoyed family time more than I have this year. It made it all the more hard to go back to work on Tuesday, but to be honest, I didn’t even have time to think after I was thoroughly ‘beasted’ by the sheer amount of calls coming in. As I mentioned on Twitter last night :

I came home absolutely shattered, but pleased that we had helped so many ‘genuine patients’ and their families.

As always, there are a couple of jobs that will stay with me for a little while and families who I will have in my thoughts as I say ‘Happy New Year’ as the clock turns past midnight.

We will always be a witness to sadness and grief in our line of work, and I have been ‘splashed’ with more than enough from 2010 (credit again to Chris Kaiser from ‘life under the lights‘ for the term ‘splashed sadness’), but I am immensely thankful that my family remains intact and relatively healthy as we move into 2011.

In 10 minutes I will be heading out to work another shift as the Police Medic for Durham Constabulary in Darlington tonight. I know it is going to be a busy one and I know that as it gets closer to New Year I will wish more and more that I was at home with the family, but for as long as I can remember, both me and Mrs999 have been out working on this night.

Yes, it will be full of drunk patients, but hopefully they will all be happy drunks!

As for you lot……..

I wish you all health and happiness in 2011.

As I have most definitely found out since the start of Chronicles of EMS, we are all in this thing together!!!

I was brought up knowing that I should be polite and courteous at all times, which makes me feel a little odd when I look at my stats for this blog and see people like your good self coming back time and time again to see that yet again, I have not posted anything new.

Things have got a little tougher with university as well as another writing committment I have, which sees the blog taking a back seat again for a little while.

I guess that rather than leaving people guessing when I am going to put a post up, I have decided to spend the Christmas period with my family and my text books. I have three large assignments to get finished and submitted by the middle of January, and I am enjoying the time off with the family immensely (when I am not stressing about Uni work).

So…..unless I suddenly have a large increase in my brain capacity and discover how to slow time, I am going to have a Christmas holiday from the blog and not just try and get something out to you all just because I havent for a while. I have many drafts written to various degrees and these will all be up in the new year.

Until then, I sincerely hope that you all have a great Christmas time and a wonderful New Year week. For those who have wangled time off over the festive period, have a fantastic time with the family, and for those who are dutifully reporting for work and helping those in need, thank you and stay safe.